the medical records trigger the requirement to order an exam in the name of quantity. instead of serving the evidence of an attack does substantiating the need for regular skilled care. common sense will give way to a calculator, which is supposed to be decision support tool, not replacement for once reasoning faculties. to make this point, i offer an analogy. three plus two always equals five and if every disability metrics like decibel level or percentage of range of motion will be achievable under the current system. these claims are like adding to or rational numbers. hi, 3.14, so on and so forth plus the square would have to to arrive at an outcome that could not be precisely found with a calculator. these claims call for an informed qualitative analysis to find the most accurate albeit imprecise answer. that answer is never found in san diego cases the claim ultimately died in the veteran finally succumbed to assail us.

this is a missed opportunity to do the right thing. unfortunately, this is not an isolated case. we see step across the country point to the was suggested by taking the unnecessary steps in similar cases. i can point to and in nashville for ms. mcdonald who will testify and of course in new jersey, i also have a case for you if you're interested. we understand the dilemma to reduce the backlog while achieving timeliness and accuracy targets. ..

in these claims with answers binary prop suggestions and. thank you, mr. chairman. and member of the committee. i'll be happy to answer any questions you have. >> thank you. i recognize mr. abrams for five minutes. >> thank you. i've been involved in veteran's law for over 40 years. the va has faced huge backlogs before, and the va has had to deal with reducing the backlog claims faster, and almost every instance the error rate, especially the error rate for complex claims has gone up.

you simply can't go too fast when you have complicated claims. the fist thing we have to talk about is what is a complex claim. some claims by their very nature are complicated. special monthly compensation traumatic brain injury. the regulation dealing with tbi is so complicated that some people call it the i did -- da vinci code. look at it sometime and you'll be impressed. some claims can be complex as they are developed by the va. or as evidence from the claimant comes in. ancillary issues arise, different theories of service

connection come up they can become more difficult. and some claims more than a few and more than i like can become complicated because va error. and in those cases the veterans face a nightmare. not only do they have to get the right evidence before the va they have to overcome the unfair denial which is an obstacle that stands in their past. the worst type of vaers are the premature adjudication. some varo incorrectly adjudicated and prematurely deny claims based on an adequate evidence. especially an adequate va exams. these errors reveal for many

veterans that the claims process can be adversarial. based on my experience, working for the va for many years working for n vrk ost. going on quality checks to over 40va regional offices for the american lee gone who should be commended for doing that work. shows to me that the error rate at the va has been consistently, at least 30% in the various ros. sometimes it's higher. it's unrealistic to assume that the va will ever get it real error rate to 98%.

over 70% of the claims appeal to the board of veterans appeals are reversed or remanded. and over 70% of the claims taken to the court are sent back because of the va error. in it rush to judgment, we have found that many ro varo prematurely deny or ignore many claims and potential claims. unfair premature denial cause unnecessary appeals and years of delay before deserving veterans obtain justly iraned -- earned benefits. and even more important, some

veterans fall through the cracks. if many are done in a premature matter and many deserving veterans are unfairly denied. what will happen is veterans be appeal the backlog will vently grow and be facing this over again. i wish to comment the undersecretary general hickey for her commitment to the fully developed claim program. i think it's the best thing that the va has tried in over 40 years. and i encourage it. we suggest the following. the va measurement system which is encouraging people to prematurely adjudicate claims.

has to be over hauled even if congress has to pass a law. the va needs more people to work these claims. inspite of electronic this and lanes and all the other things the va is trying to do, which is a good thing. they need more people to work the claims. finally, the adjudication culture at the va needs to be changed. many va managers that we've met on our travels act like they are producing wig ets rather adjudicating claims filed by real people. you saw the real people here today. their bill should not be prompt adjudication, the goal should be a time, accurate, and fair

adjudication, which in the long run, not in the short run, is the best way to finally adjudicate claims and reduce the backlog. thank you. >> thank you. with that we have pending votes on the floor. we may get to questions after mr. hearn. if not we'll go to recess and questions after we come back. >> good afternoon, mr. chairman. ranking member tie titus and members of the committee. we're here to talk about the implementation of special operations lanes. these to address accurate sei. what we never talk about why accurate sei matters. va estimates they will process over a million claims again this year. the difference between their goal of 98% accurate sei and 97% is over 10,000 veterans who may not get the better -- beforts they earned. we know the real gap in accurate sei is far more than 1% as

well. that is why the american legion is constantly raising the importance of accuracy. those who wind up on the wrong end the accuracy rate may be stereo. why still problems? it's a complicated system. it takes experience and attention to details to get thicks right. putting experience pearls tell me on tougher claims is good start. when they -- across the country with the right personnel to execute this plan it will probably help with improving the figure. but there are still some systemic problems which hamper the ability to get it right for veterans.

to see inside the officers outside the bellway and get a true picture how it borics in the field. through these visit we've seen patterns. for example consistency from one office to office leaves much to be desired. policies embraced by leadership and one office may be given lower priority in other officers. with mixed commitment you get mixed results. va officer seems to struggle with finding the right balance and development for claims which leaves to adjudication. you can't build house on a shaky foundation. on our review visit we exam a sample of claim for veterans. the american legion represents. often it's been under developed or overcomplicated. both of these errors are a recipe for bigger errors later in the process. for example, in april of 2013 we

visited the nashville regional office. according to the april 27th monday morning workload report they had a 95% accuracy rating. during the review of 22 cases we found 11 where we commented regarding case development to include 7 with errors. our review paints a far dimmer picture of accuracy than indicated in the workload report. in one case a veteran was seeking service connection for ptsd. evidence indicated the veteran served in the persian gulf during desert storm and was fearing death. no exam was provided by va. denied the service connection for due to a lack of diagnoses.

deny the veteran benefits without due process. conversely, sometimes va doesn't seem to know when to stop and overcomplicate the claim. in june we vet visited the reno. the june 3rd reports indicate they had 92% 2 accuracy rating. our review of cases resulted in 59% of reviewed claims for va benefits. in one instance a veteran was seeking service connection for ptsd. during a july 2011 exam the examer linked the veteran's condition to military service. the regional office returned the results to restain his opinion and again the examer stated the veteran's ptsd is related to service. after the second review they adjudicated the benefit in september of 2012 and sent the notice letter in january of 2013. va conducted two exam when only

one was necessary and took over two years from the date of the first and another four months to november it. the american legion believes adopting the strategy. it needs to start with the right mind set. it should not be achieving 98 percent accuracy. it needs to be i need to get every step right for this veteran. until the problem gets fixed we're losing the good faith of the city of veterans every year. thank you, i'll be happy to take questions. >> thank you. there's less than five minutes left we're going have to go in to recess and be back half hour to 40 minutes. so the committee stands in recess.

[inaudible conversations]

[inaudible conversations] recessing the hearing briefly coverage of the subcommittee will continue when members get back from voting on the house floor. and when we return, they'll pick up hearing with more testimony from legal advocates. and processing complicated veterans disability claims. three panels in all are scheduled for this afternoon. some news of the associated press writes that the family of a florida woman killed during the shooting at the washington navy yard is the first to file lawsuit against the federal government and contractors. claiming they ignored red flags about the killers'. and a suit named the navy the department of veteran affair, and two deafen contractors as the defendant. and is seeking at least $37.7

million. until the committee return we'll hear about the relationship between president obama's cabinet and his closest ally. the cover story in the new "politico" magazine. susan is the editor and editor in chief john harris are with us today to talk about it. let me begin with you. why did you decide to launch a magazine? >> "politico" -- first i thank you. i'm happy to be here to talk about the project. everyone is very excited about the content and we're excited about susan the distinguished career as washington editor. we're excited to have her on the team. the reason we launched the mag diseent consistent with the larger mission. "politico" is about to turn 7

years old. we've had as our mission for sometime we want to be washington's dominant news room for coverage of national politics and policy making here in washington we want to be the dominant player in that. it's a vigorous competition day in day out. in order win the competition we need to do a lot of things well. historically when "politico" got started back then when we were an organization of 55 people. now an of organization of almost 300 people. from day one i think we did several things well. we were really good at fast off the news of being the place to go for

it is something i felt ambition to do. in order to do it they had an incapacity to do it. susan is that editor. she had a previous track record of having that successful -- creating successful enterprise. we've been talking far long time about how we can get her and we were smart enough to way. that's the idea. >> host: so print is not dead? >> guest: it always sounds like a cliche, but the fact is the cliche has a lot of validity to it. we are truly platform of the agnostic. i think anybody who ambition in journalism is the fixation with the platform whether reading it in print or whether you're reading it speaking on your computer increasing whether you tread in mobile devices. that's is not the point. nobody cares about that anymore. not reader, and increasingly not advertisers. what they suspect journalism

with impact. and they want distinctive content. there's no market. with the audience no market in the business side with anything that is commodity journalism. we're not interested in that. they are interested in distinctive content. and there's a lot of ways to be distinctive. one is to be by being really smart and finding targets for deep original reporting and thinking and writing in a magazine format. historically that kind of journalism found the -- we have a print edition six times a year. we have a weekly edition daily. there's a daily "politico" magazine with argument opinion and more ambition enterprise journalism. that's what counts.

>> host: take a look at your first edition here. "locked in the cabinet ." you have to have an impact. how do you have an impact in the magazine that comes out six times a year that is also relevant as the cycle go on in a twitter pace throughout the day. >> guest: well, you know, i think it's a great question. "locked in the cab innocent "is a great example of what we're trying to do. it had an impact. first of all, it was probably the longest story "politico" has run. it was an ambitious piece of writing. they interviewed more than 50 people including numerous current and former cabinet sector. many on the record painted a stark portrait and really got mind the scenes of the white house by coming through another advantage point. i think that speaks to the mission what we're trying to do. i think that at the time when

people perceive it as a hard white house to crack. that's what david called it the other days from "the new york times." glen found a way to tell us something fresh and significant about how president obama governed. it did it in a 7500-word print magazine story. it ran online on the new website. it was one of the most highly trafficked stories of the year. there were more than a million page views so far for the long magazine article. i think it's challenges a lot of those incorrect conventional wisdom about what people will and won't read line. i think it's the kind of ambition that we're aiming for. which is to say to breakthrough the clutter and recognize that you can live in the twitter news cycle but don't have to be a captive of it. good journalism tends to do very well both in the dwitter world and beyond. and i think, you know we're not

looking to unleash a flood content. we understand we are all drowning in information. we're connected with "politico." we're a part of "politico," which every day as you know, is pumping out tons of stories and items and updates and videos and news letters inspect is a robust journalistic echo system that already exist. what is the mission of a new daily publication like this? it is a daily publication. t to offer you a cure rated space, you know where smart editing and reporting has gone in to it. you can step back and here is four or five smart things for you to consider today that are relevant to the stories in the news cycle or perhaps looking outside of them. here is a cover story that is a reported piece, you know from iowa from colorado. here is a smart opinion piece by somebody whose perspective matters. it's a kind of value we are trying to add. we are publishing it.

here is the new edition, again to breakthrough the twitter clutter rather than to become a part of the noise. >> host:let dig to the content. >> guest: it really amplify susan's point. i think it's important to anybody who cares about journalism. it is true on the web there is a clearly a certain market for any kind of nonsense or validity. nobody is immune to it. i think some is very perishable and weak. and some is really fun. with susan's publication they did the fun example if she'll forgive me. dogs that -- >> guest: hairless cats. >> guest: that gets a big traffic. that doesn't bother me. but i do as somebody committed my life to journalism. i want to make sure it creates a big audience. the fact of the 7000-word piece can be one of the biggest of the year enormous traffic. that says there is a market at

both ends of the food chain. it's really important. the future of our business and the future of our profession depend on being able to connect with an audience. >> let's dig in to the content of the cover story. i think it's pertinent to the news this morning. new york times report somebody needs to be held accountable for health care.gov. democrats are calling on the administration, the closest allies are calling on the administration. you need to fire someone. what is it like to be a cabinet secretary in the obama administration? >> guest: as glen's reporting indicates, it's a signup for the duty is almost by definition accept a certain amount of frustration and disappointment. and particularly frustration and disappointment if you were one of the cab net officers that believed the storyline that president obama worked very hard. it was going to be a team of rival that captivated by doris goodwin's book on lincoln.

and he was talking in ways that made us think there might be a revival of cabinet-based government. if so, that would have been a departure from the trend the last 50 years which increasingly centralized it. it turned out he didn't have in mind a departure. in fact it's the most centralized in to my mind insulated west wing since the nixon years. and as we have done the new chief of staff has tried to moderate that a little bit. he's been aggressive in outreach and make the cab innocent members feel more enlisted. they're not enlisted. they have an ton my and everything that the west wing doesn't care about. if itst important they don't have autonomy. they have young political aid in the 20s and 30s who are dictating to cabinet members. and several cases considerable amount of elected experience. but substantial achievement in

their life. they get the talking points from the west wind. it's necessarily a frustration. i think some cabinet members deal with the frustration and in their own targeted way push back against it. more effectively than others. >> the quote in his piece from we are completely marginalized until the you know what hits the fan. if your question is did the president rely on the cabinet as a group of advisers. no, he didn't. well, and i think that pretty much sums up the by and large consensus we talk to. picking up on john's point. it was a. a. it wasn't they were left to do their own thing. of it a sense that politics ruled in at white house because the first mission of any

first-term mission is from a second-term president. i think it was the orientation of how the west wing was structured in that first term. it was a readies contain for many folk. steven chu was the energy secretary for the first four years of the obama administration. a nobel prize winning physicist. a brilliant guy. and the opening ante-dote of the story basically shows how the aid to president obama considered him literally a political aid yacht. and they wouldn't let him talk on the expertise about climate change. they were so concerned about how disruptive he would be. their messaging and i think that's the tensioning inherit in the conflict we're seeing playing out over health care right now. at the end of the piece we get in a little bit to the tremendous vail of kathleen who had several years of quiet service as a secretary of health and human services now under fire many calls for her to resign as a result of the botched rollout of obamacare.

i think you have to look at what was the message she was getting from the white house as this website was being played out. was she empowered to do that. tom daschle was going to be the secretary of health and human services. glen reports in the piece, he was a can any washington operator. a former majority leader of the senate. when he was going to take the job he specifically negotiated for an officer in the west wing of the white house and status as a senior adviser to the president in addition to that cabinet portfolio. his nomination was derailed because of an un-related tax problem. but i think there was always a sense among the political operative he had the kind of political juice that she never did. of course, in a crisis so needed. >> host: john harris. the president should in order have americans trust health care and thrust the government again. the president should send that

message and fire someone. >> >> guest: yeah. as i understand it and gibbs made that comment. it didn't surprise me. it is a classic problem that presidents face. in bush-cheney years there was a lot of this. okay we somebody's heads needs to roll to still the political waters. and sometimes that works. and sometimes it really just amounts to an acknowledgment of weakness. it's what cheney argue. throw them -- the wolf being opposition and us in the press all they do is get hungry. that, i'm sure is the debate that is taking place in obama right now. which is look does it actually resolve something or does all it does is acknowledge that we fail and em bolden the opposition? so the politics are ambiguous.

you know, beyond the politics though probably another thing he's thinking about. the -- this was a signature domestic achievement. it wasn't coming what hurricane katrina. it was coming as a long-planned event and the roleout of disastrous. something went wrong. and someone is responsible for that. whether that is west wing or deep within the bowl of the health and hiewfm services or secretary kathleen. i don't understands the problem well enough it know. someone is accountable he kim toot presidency without a lot of executive or administrative experience. in certain times up until now it's not a problem.

>> why politico pushing for president obama to shake up the cabinet. there's no reason to call for firing anyone. [inaudible] >> guest: but -- >> host: let's get our viewers involved on the phone line. john is up in north brooke, illinois. democratic caller. hi, john. >> caller: hi. >> host: thank you for waiting. go ahead. >> caller: i just wanted to ask one of my favorite parts about "politico's" website they have a fact-check section. and my question was have how do they choose [inaudible] i don't know if they were able to hear the previous but to show -- fact check on your website. [inaudible] and have someone look at it -- >> host: all right. john harris. >> guest: i thank the caller for reading "politico."

some news organizations have for reasons that i understand sort of make it a feature. there's, you know, sort of graphics or whatever with the thumbs up or a thumbs down or the nose getting longer or shorter based on something true or false. that's a clever way to do it . we made a choice not to do that. we integrate in to the coverage as they matter of routine. if something is misleading or false. we try to say so. in that sense, we have to have confidence of journalists to be liberated from the journalist of convention of some say x and some say y. some say it's sunny some say it's rainy. through the report there's a factual answer it's raining.

i encourage reporters to do that. we are fair but there's also factual truth. that's an important part of the mission. >> let me go back to the cover story of the first edition. the currented a min appear to be obstructive. secretive and dishonest. it's hard to trust the obama administration. >> guest: these are partisan times. i think we one thing that has surprising me coming back to the world of politics after the last five years as editor of foreign policy magazine is just how super charged this conversation is. and everybody -- wants to view -- that's, by the way why i think it's so important what john said. we are here to do independent reporting. and, you know, i hope that callers and viewers and readers can look at it for what it is.

it's an important part of the documentary record, i think. it's interesting to hear what the cabinet members have to say on the perspective on the white house. what does it mean? you know there's a famous joke about the chinese when asked by nixon about the french revolution he's waiting to see how it turn out. i think we're waiting to see how the obama administration turns out. >> caller: hi. my question is when are you all going have ever print anything good about obama? because he has done than you have given him credit for. [inaudible] the situation -- [inaudible] paying taxes. and not getting -- representation and too many people that are getting in to office are not representing

areas they are elected to represent. [inaudible] >> host: let me jump if. do you go to "politico".com? have you read "politico"? >> caller: yes. >> host: you think they have a bias? >> caller: yes. anything but the whole truth. >> guest: well i don't believe that from houston texas. i believe it's dan calling in the west wing a plausible texas accent. >> host: do you get it from the white house? >> guest: we do. there's a belief we accentuate the negative. i'm nondefensive about that from ann from houston or dan from washington or from others. i don't accept it. i think if you read "politico" day in day out you'll see us look at the political leaders we

cover. good stay days and some days bad. some in the positive or some that clearly go in the negative ledger. it's just the nature of journalism. so we are committed to fairness. i think coming from the perspective of partisan. i don't criticize them. they have strong views and strong view about it. i think coming from that perspective 2 often looks you're in the perspective of the opposition why are you playing patty cake with the -- that's what democrats said during the bush years that the prez was too soft. it's not the criticism is never accurate. i think often that criticism is really incomplete and doesn't reflect an actual understanding the record. >> host: james tweets in. val i are calls that.

what is the her role? in the administration? >> guest: there is indeed a wide spread belief that the president is an unvaluable cons leer to the president. i think a very interesting situation where she is a key ally of attorney general erick holder. and the two of them have not only professional relationship but close personally to the first family in ways that clearly have affected the dynamic of how obama deals with some of his top advisers in the white house and out. i believe he became aknown to erick appeals court. when were there were issues of dispute between holder and the staff of he was appealing directly to obama over dinner or going through her.

> host: who is the president's closest aid? >> guest: i have to speculate that in term of the intersection between his political life and personal life is valerie. i don't know she's the most influential on policy debates. i'm struck by what i read on "politico" and elsewhere in the rising influence of dennis mcdonna. it's clearly somebody who the president has a personal affinity with. i think it's notable that something strong skill has risen as a staff persian. nos as somebody who effectively had a background as a principle of his her own the way rob emanuel did.

i think that mcdonna clearly is an position of influence. when you talk about the pack of wolves calling for resignations or asking somebody to be held accountable. people say wait minute. if it's an administration run by the west wing. the chief of staff should be held accountable. again, to be clear i'm not making judgments about whether anybody should be fired or who. but mcdonna is clearly carrying some of the burden. >> and "politico's" website has this headline ""politico" health care.gov problems on me." rose in chicago. democratic caller. >> caller: wow, it looks like he watched the interview on qna with the chief of staff.

i have a couple of things to say here. first of all, when was the last time media did some self-reflecting? you know, crb news and what they've done. let talk about [inaudible] no one need to hold. chief of staff should be held accountable. greta asked i don't know how many times how kathleen to be fired. yet ignores all of -- look at the census. do you remember the census failure in 2009 from the harris corporation out of texas? do you remember the air force debacle. $1 billion nothing to show. at least we have a website today, folks. greta, the website is working. the $1 billion for the air force nothing to show greta. no census greta. nothing to show.

no one was fired, greta. >> host: okay. rose we got your point. republican caller in texas. >> caller: hi. my thought last week and two weeks ago president obama kept repeating things like you can keep your doctor and the whole scenario of all that. he kept repeating over and over and over. and i had thought had i always thought of him as the president of the united states. but it occurred to me when he kept saying that. it was almost like someone hiptized it occurred it came to me thought. the whole group that got in to the white house may be using him as the mouthpiece for the whole group. anever would have got ton the white house as someone articulate as president obama. and he is. >> host: who is the whole

group? >> caller: i'm talking about a group of progressives that wanted in to the white house and they wanted to be in it regardless of whether they can get elected or not. but president obama seemed like a good candidate to be their mouthpiece. it's kind of what he's acting like. because nobody ask get fired because they are in charge. and he isn't. >> host: okay. >> caller: it occurred to me as a possibility. >> host: all right. susan, just talk about the cabinet secretary and how much power and influence they have over the president. >> guest:s a john said there's a long-term trend of centralizing in the white house for various reasons including by the way, the extreme difficulty we now face in confirming anyone for any job. there are 200, i believe, senior administration nominees right now that are waiting for conformation from the senate they have not yet approved. so, you know, think about this. the chief of staff of the white house doesn't need to be

confirmed. he serves at president. and there are many even structure reasons as opposed to just president obama's personal preference for why power resides. the question is really you know what is it a structure of government that works for a very different moment in time. you think about health care.gov. right. one of the questions i have going forward. aren't we going to face more challenges like this? government just like media organizations is going need to figure out how to operate in a much more digital era. we are connected to people and they're having a conversation with people wholly outside the one that is in their experience. and i think that points out in the same that perhaps the ed washed -- edward snowden disclosure of information point out. we are entering new era of government. our government is built on a 20th century cold war model. >> host: john, does this

cabinet and its relationship with the president differ that much from previous presidents? >> guest: that's a good question. to me the key variable in the modern presidency, and this is applies to obama but not just to obama, certainly. the president i cover closest bill clinton. but all the recent presidents is degree of personal connection that a president feels and when there's that personal connection, there's the possibility of a relationship that is more like a west wing relationship rather than a cab -- cabinet. tim geithner had a rough time at the start of his term as treasury secretary. but by the end he developed a relationship where i think obama relied on him. and he disrespect a sense that he was the treasury secretary.

sort of bold -- you know capital p capital s. he was dealing with tim. my guy who i trust. who i like and respect. and who was in the west wing constantly. probably as much as he was over across the street at the treasury. and other people, i think haven't had that relationship. i'll tell you there's a couple of books i think are going to be interesting when they come out. secretary gates is writing his memoir. what is he going say about the question his relationship with obama? leon panetta what is he going say about this question? i had a sense that neither of those two did in fact have that degree of personal connection with the president. i think, you know, on the gates book, i think it's supposed to come out in jan. we report in the piece actually

that engaged even remember he worked for both bush and barack obama and even compares obama unfavorably in some respects to bush which i think will be a eye-catching statement on the part of these widely respected sort of national security professionals. although a lifelong republican who agreed to serve in obama's cap -- cabinet. >> host: greg next in virginia. democratic caller. >> caller: hi. one thing i wanted to say. number one, i'm of the belief that roll out the health care.gov website had a lot of problems. i think it's been way overblown. i look forward to katherine testifying to give some actual concrete number. and i bet we'll see yeah there was a problem but it wasn't this disaster that so many people and most of the republicans have been describing it to be. the effect on the present

population is far less than the republicans might have you believe. and the next thing is you know instead of the republicans jumping up-and-down you can keep the health care plan if you wanted. looing at this pulling up little examples people who lost their health care. you know -- he's going take over the insurance company. the insurance company on the ones who are making the serious -- canceling these plans. there's nothing in the law that requires them to do that or says that say that have to do that. so in that is really that promise has been kept but do control the insurance company and make them keep the plan active. i think it's an important thing totally missed by the recorders, the meet ya and intentionally missed by the republicans out there who are against the plan. the last thing -- >> host: i'm running out of time and leave it there. >> guest: there's one point i really agree with and one point i do so much agree with from the

caller. the point i agree with is the failure long-term of the affordable care act will not rise or fall on like a website. if amazon and southwest airlines can do they have a website that works and likes like maybe we are getting closer to that goal. it's going to be on whether if meets objective of expanding coverage in a way that is affordable and not too disruptive of people who currently have the coverage. i think he's right about that. the fixation on the website is ultimately seen as the -- i don't think he's exactly right is that in term of the cancellation in fact the law did contemplate the plans that were grandfather that i had in changes since i think 2010. those were expected to be canceled.

the centralized pressed aim of the policy. a lot of people out of those low cost and low coverage plans precisely so they can go in to more expensive plans that would provide the revenue to accomplish the other goals i. e. coverage for people who are older and more expensive and preexisting conditions and more expensive. that's the idea behind the affordable care act. you expand the pool of people. that would pay for the expensive part of the equation. >> back to the cover story. what is the president's relationship with kathleen like? >> guest: well it's a good question. i think it's a mystery. my guess is not super close. there's a famous story we talk about bob gates. these are big groups of people 20 something people in the cab innocent con i continue let's is a rice recount her memoir where

she's secretary of state and bob gates is secretary of defense in the white house meeting. a nice middle east gentleman comes up. it's nice to see you. gates said who is that? and sir it's mike levin our secretary of health and human services. [laughter] remember these guys aren't getting a ton of face time in the oval office with president obama. >> that brings up the tweet from ron. short answer little about the access. obama is micromanager. ask john kerry. >> guest: that's interesting. i'm not sure it proves the tweeter's case. kerry has been given a fairly wide leash when it comes to the white house or taken one. it's a little bit hard to say which. he's been an active secretary of state so far. seeking to reopen middle east peace talk. most think there's little chance of brail through there. he's dealing with the headache of getting an arrangement force

to remind in afghanistan. he's negotiating syria peace talks. negotiating the iran deal. kerry is out there and probably impossible micromanagement him. >> i believe it was "politico" that reported that the president made the decision on syria to not go to war with them without cutting the secretary of state. >> that's correct. that's one of the other items. it's been reported and documented elsewhere as well. in september you remember obama made the decision he was going intervene militarily in syria in order to respond the chemical weapons use by the assad regime at the very last minute after a walk on the white house lawn with his chief of staff he said guys we're going change course and go congress for authorization. john kerry and secretary of

defense were not there. dennis confirmed they were later informed by telephone call. was an impassioned john kerry speech in favor of the military intervention. . >> host: go to marry in fairfax, virginia. >> host: you're on the air. ged. >> caller: i want to say -- [inaudible] [inaudible] it's very sad the republican from the tea party have an -- [inaudible] after my divorce i had two i'm jobs and no insurance and an emergency surgery.

i know, -- [inaudible] without medical insurance -- [inaudible] and people don't realize that president obama, i mean [inaudible] he's the president and after a huge mess -- [inaudible] yesterday i saw on msnbc a horrible, i mean, informing the republicans who -- [inaudible] seeks different websites. >> yeah. the california republicans are sending people to a website that doesn't necessarily help them with navigating health care.gov. but i think on the larger point about politics and poll numbers here. on this issue of the affordable care act act. the health care.gov. what is happening here with the president and john harris? and inside the white house as they look at the poll numbers? >> guest: i think they are

recognizing that this issue, if it is not reframed in public perception has the potential to define barack obama's second term in an adverse way. and not going to submit to that willingingly. i think we're seeing a very aggressive campaign just underway now to get the emphasis off a problems and remind people what the benefit of the affordable care act are for people like the caller and others. there are basically trying to resell the bill >> host: we have to leave it will. the house is coming in for the legislative session. i want to tell the viewers if they are interested in "politico" magazine. you can follow them on twitter. thank you very much. >> guest: thank you. >> caller: thank you for being here. >> guest: i appreciate it. we are expecting members of house veterans affair subcommittee to return when votes are finished on the house floor. they'll continue the hearing on

processing complicated disability claims with testimony from legal advocates. earlier if in the first panel one was a widow of veteran who said she's been waiting 23 years for her government to play a claim who died after exposure to agent orange. you can see that panel on c-span tonight and later at c-span.org. as we wait for members of the subcommittee, we'll see president obama speaking at the youth summit today encouraging people to sign up for the health insurance exchanges. [inaudible conversations] [applause] hello, everybody. hello, hello. hello. oh my goodness. you look terrific. goonch and welcome to the white house. it you can say hello back. [laughter] you can be interactive. come on! exactly. we are so thrilled to have you here. there are so many, so many accomplishments that the folks

from this room have done already and helped me promote the affordable care act. but we still have a lot of ways to go. we were talking back stage with a few folks who were leader of your group. they said we have a plan and now we have to execute the plan. we all know it is so important that we reach the young folks around our country. and i'll tell you a story which is going get me in huge trouble back home with my daughter. when he graduated from college, she was looking on the site and try fog figure out how to get insurance and said it's going expensive. i said honey don't you under the affordable care act you can stay on my health insurance until you are 26 years old? and so the moral of that story is that my daughter still isn't up to speed on all the information. we have a lot of work cut out to us. that's what you want to do. you are out there each and every day talking to your peer, open counselorring young people to get educate about what is available under the affordable care act and encouraging them to sign up. and so for that we are grateful

for your effort. now i have a little bit of a surprise. which isn't probably that much of a surprise. you seat the ram. they didn't actually come here for me. they came here in order to capture on film the person who has come to giver you a special shoutout for your efforts. please stand up and join me in welcoming the president of the united states. [cheering and applause] hello, everybody! hello, hello! good to see you. everybody sit down! good afternoon! [cheering and applause] welcome to the white house. it's a little bit of rowdy bunch. the -- well, it is wonderful to be with all of you and i couldn't be more appreciative of automatic the stuff that you guys are doing all across the country in your communities in your organizations. there was a time when i was a

youngen in school. after five years in this office, people don't call me that anymore. [laughter] i wanted to drop by and say thank you for everything you've done. and will do spread the word about the affordable care act and what it means for young people. about a year ago i got a letter from a woman in her 20s she graduated from law school. she wrote thank you for making health care reform a priority. if you haven't, you probably would have fewer gray hairs right now. [laughter] that's a good point. but her stories is a reminder that the law was worth a few gray hairs. she was one of the million that it helped to cover. they could join their parents plan. when she was diagnosed with a potentially deadly autoimmune disorder, she got the care she needed. medication, blood transfusions,

ultimately life-saving surgery. she was able to stay in school and graduate first in her class find a job in her field. and she wrote i'm grateful because the affordable care act saved my life my family from bankruptcy, and gave me a future. ..

you are not going to have to wonder whether or not you can do that because you're worried about coverage. we need to settle down and start a family, maternal care will be covered. if you're a woman, you won't be charged twice as much as men because you are the one carrying the baby. so this thought is already making a difference for millions of young people at about to help millions more. about half a million people across the country already are poised to gain coverage on january 1st. some for the very first time. one recent article reported a surprisingly large number of young people are signing up and there's a good reason for that. the law works. most young people without insurance can now get covered for under 100 bucks a month. i am not allowed for security reasons, to have an iphone. [laughter] i don't know what your bills are. i have noticed that sasha is

only asking to spend a lot of time on it. [laughter] my suspicion is for a lot of you, between your cable bill phone bill you spend more than 100 bucks a month. the idea that you would want to make sure that you've got the health security and financial security that comes with health insurance for less than i praise coming in now come you guys are smarter than that and most young people are as well. the product is good affordable. people want financial stability of health insurance. we will keep working through any questions, problems that may. obviously, the website, when it was first launched wasn't in tip top shape to say the least. but, we have been 24/7 going on it and now for the vast majority of users, it is working. there will be other things that

come up during the course of the next several months because you are starting off a new program that has an impact on one sixth of the economy. this is a big deal to quote joe biden. [laughter] but we are going to just keep working on it and approving it and assigning it. if we see a problem, we'll fix it. but we are not repealing it. not as long as i am president and. [applause] particularly because the folks who are criticizing it don't have any ideas in terms of how to reduce cost ensure millions of people get coverage for the first time, and make sure that insurance is more secure. those are things the law is already doing and we have to just make sure that people know about it. that is why i'm here because they need your help. that's why you are here, because you know i need your help.

believe it or not their organizations working to convince young people not to get insurance. think about that. that is a really bizarre way to spend your money to try to convince people not to get health insurance not ticket preventive care, not to make sure they're able to survive an accident or illness. if i had that much money, i wouldn't be spending it that way. some of these ad campaigns are backed by well-funded special interest groups. i assume they've got great health care. remind your friends and peers. imagine what happens if you get sick. what happens at the massive dose? they're not going to pay for your illness. you'll pay for it or your family will pay for it.

look, i do remember what it's like being 27 or 28. aside from the occasional basketball injury, you know most of the time i felt like i had nothing to worry about. of course that is what most people think until they have something to worry about. but at that point, oftentimes it is too late. sometimes in this debate, what we've heard are people saying well, i don't need this. i don't want this. where you impinging on my freedom to do whatever i want? part of what i say to folks when they tell me that is if you get sick and you get to the hospital and don't have any coverage comest among us is also going to be paying for it. it may be your family that can't

afford it. or it may be everybody else who does have health insurance and the fact and responsibly and is essentially subsidizing for your care. and that is not what i think most young people want. they want to be independent. this is part of feeling and being financially and from a health perspective secure. so i'm going to need you out to spread the word about how the affordable care act really works, what its benefits are what its protections are in most importantly how people can sign up. i know people call this law obamacare. and that's okay. because they do care. [laughter] i do. i care about you. i care about families. i care about america. [applause]

no matter how much i care, the truth is that for your friends and family, the most important source of information is not going to be me. it is going to be you. they are going to trust you if you're taking them on a website walk in the spirit come to seem like the price are able to get, benefits, that is what makes the difference. if your student body pressed back, set up a conference on campus. if you work at a nonprofit, open your doors. use your e-mail list to help people learn the facts. if you've got a radio show, spread the word on air. if you're a bartender, have a happy hours and probably get health insurance because a lot of bartenders don't have it. put something on your facebook or in supreme. you can tweet using the hash tag to get covered. do whatever it takes to make sure people have the information they need to make the decision that is right for them. if you're in a state that has

its own state exchange, they probably do a lot of activities and you should plug in for. if you're in a state that so far has not decided to set up an exchange, obviously we can make sure you have all the information you need to succeed. the bottom line is i'm going to need you and the country needs you and a lot of your friends and peers, they may not know they need you that if something happened somewhere down the road , where they really need to get to a half killer dr. the fact that you have talked to them and got them involved will make all the difference in the world. finally, let me make a broader point to all the young people here. this whole exercise obviously has huge implications for the country's future. because if we can start earning down health care costs, make sure people are covert comic of people financial security, and

it's good for economy businesses, the federal budget. but i hope you haven't been discouraged by how hard it has been because stuff that is worth it is always hard. civil rights movement was hard. giving women the right to vote, that was hard. >> subcommittee will come to order. we will begin a round of questioning. i will start that off. my first question will be for mr. abrams. you note in your written testimony that one manner in which claims become complex because the va error. cases that disorder often appealed angry man had. often more than once further increasing the complexity of the claim procedurally. number one, can you elaborate on the common errors which causes claims to be more complex due to va error on appeal? and number two, to think greater focus on appeal and remanded

claims would assist va learning from it mistakes and making less of these types of errors in the future? >> yes, i can. let me give you an example. suppose a veteran files a claim for pts d. the veteran alleges that he suffered a stress the next goes to combat. the veteran service records show a combat infantry badge which means the veteran was in combat. however, to be a comment in an effort to go fast set up an examination and fails to tell the medical examiner to accept as true the fact that the veteran was exposed to combat. the va examiner looks at the

file, doesn't see any evidence of a stressful and then in service. doesn't know how to read etd 214 and determined he could not diagnose ptsd without a stressor. therefore, he right a negative medical opinion. and diagnoses the veteran with anxiety disorder or something like that. the va then denies the claim. to resolve the claim could take five to eight years. the va needs to take the time to start. this is just a simple error. i could get into complicated ones that we be you're much too late. that is a simple error that can be fixed at the va takes the time at the start to tell the doctor what evidence to accept as true.

that is not for the doctor to determine. as for the adjudicator, the va adjudicator to make that finding. your second question was if they got more involved. i'm not sure what you mean by more involved. with free man's? >> a closer attention to the process. >> well, they should. they need to analyze the types that come back from the word and take action to train on that. we start my look at thousands of cases a year and keep a list of the common errors the va makes that we can win the core four. in my testimony, we listed some of those that you can see. i am hope being that the va does

that. i am not sure that the two. >> thank you. again, for mr. abrams said mr. gill's tummy both provided your written testimony issues with adjudicators probably topping monthly compensation for us dearly disabled veterans. why do you think that calculating snc is so problematic for va adjudicators? >> to operate answer that first quick >> yes please. first of all in my experience and i think you have staff members who have traveled to you know our rose who have seen that. snc is inherently difficult

issue. the va looks for magic words that aren't there. and the case i wrote about in my testimony, the veterans military doctors said he had lost all function in his right hand. he at last the use of his right foot. the va did not concede loss of use of the right-hand because the doctor didn't say the magic word. when they contacted the doctor, the doctor changed his written comments and said he had lost the use of the right hand. well, lots of use of the right-hand and massive use of the first generates an aloe. prd had an aloe because of his dramatic brain injury. this is a man who was shot in the head in iraq, had 18 service-connected conditions operates on a gradeschool level

has tubes in his head that food comes out of, has terrible scars on his face lost in the sense of taste and smell and you know, has suffered tragic rooms. i got involved because they wanted to help this guy. my heart went out to him. even after we produce clear evidence that he should get it smc are to the va did next. i was able to reach the component of the va that does the work. i asked them why action had not been taken. they told me that they were looking for lots of owl and utter control. i said that isn't relevant. you don't mean it. he already qualified.

the lady was able to hear me out. i took her through the regulations and statutes which would take me a long time to go through. the veteran ended up getting the r2. it's on our website. we had a mix of the va that the band in animal house. it didn't have lots of use. the momentum of the auction. they were going to accept those words. kind of silly. secondly, the people doing the work didn't know below. the va needs to do more to train people to understand smc. the legion ammo ph does a lot of work on that issue. if you looked in our text book we have a formula that service office there is an va can use to

properly evaluate. it's complicated and you have to look at it each time. thank you. >> mr. gillums. >> in order of the affected adjudicated claim come you have to have the tuition for things that are pretty abstract. in one case, you have a veteran with als. because he or she is trace function or a leg or can barely stand, they will find the veteran has greater useful function of legs. a lot of it over time would be cultural. this new crop are being trained to follow rules. i'll give you an example. if a veteran presents with a letter from exclamation saying that he needs skilled care that letter will trigger not some

deliberation. it triggers the need for a cpa exam. the cnp examiner will see whether this skill carries needed or not. they will dictate whether the claimant accepted or denied. if you understood essence e. yet to complete a medical opinion senate should be resolved. increasingly, this contemplative aspect of waiting is being pushed out of the culture pushed out of the process. there is no contemplation of evidence. it is either there or it's not. they've got three out of five function where they can wear the 35 tried to stand and occurs subsequent injury. a lot of it has to do with the

fact that induct the reasoning way of training it to people that made the adjudication of bit longer that's the insight. >> i recognized ms. titus for questions. >> thank you very much. two questions. first, we've heard a lot about putting these complex cases in these planes come it easy medium and hard. i understand the value of that. if that's not oversimplifying it for better understood nuance a little more. are we really creating a system that's going to produce more errors on the road in attribute to the appeals backlog is my first set of question. something i mentioned earlier the raid as you pay complex

cases. would it not hurt as the great aspects and veterans get paid for those until you get to the end. >> daylight be enable their specialists and not claim posttraumatic stress disorder, military trauma. one of our severe disability cases. that can manage from regional office to regional office. every regional offices to interrupting. the latter doing the right thing. the ones we hear about where it doesn't matter what process they have in place of the people are inadequately trained. the greatest process the world won't help them. to your question about the pay-as-you-go, for veteran who

just need relief they need some resources. it may be okay. my fear is when you pay a veteran. but the veteran gets 100% rating, the mentality would be scout 110. what more do you want? where you're coming back to us? or that is going to be a completed claim. how do you monitor the completion of that claim? for veteran's 100 getting a check, still a lot of work needs to be done in our cases. but you know we've got to make sure there's no creeping standard where they get paid that's it on the back earner. >> this past year when we were going out and doing the strips for the ftc and we visited to include the one and we know, we did discover it did bring some order to the regional office by having segmented lan. one of the things we were not

there, i would ask employees different questions. one was how much it. steve have? it was overwhelming and i would talk to coaches in middle management of seniors have two talk about the relative greatness i guess of the staff at the losses. i've heard senior leadership say on repeated occasions that while the effects of the case and the increase in claims affected the backlog and referred conversation about 9/11 and the increase in cases for mayor. the one thing nobody seems to discuss is you can't beat back the hands of time and that we now hate inherent in this country where baby boomers are retiring in larger numbers. they didn't linda va at the time initiative. soon i got this knowledge vacuum in the regional office. there just isn't -- there are enough people, but there's not

enough experience there. so it does help, but a lot of it to his he simply don't have that much asked earrings but the nonoffice. and to go to the raid as you say, i do think it would be beneficial. if you think about the effects you could have let's say someone is trying to get service-connected for three or four conditions and you can get than 50% or 60% now they've got access to health care through the va. it is a very good avenue for them. i also think that, also in the cases of preference for federal employment on when it comes to issues dealing with va mortgages for not having to pay the funding fee. of course these are important. you get money into the veteran's pocket. i do see the benefits. i agree there are some things are the least of the data as to how va would monitor this and

make sure the cases and claims are being set to the wayside while other things are occurring, but it is something worth considering i think. >> thank you. in fact it is the policy of the va that when it has enough evidence to pay partially, it pays. the problem is that the workers don't get anywhere credit and therefore, they are not encouraged to do it and we find many many cases. it is not a matter of va policy, which says when you have enough evidence, pay them at this level and then when we get more we will update. they want to take the time to do it because they are measured by how many cases they do, which goes back to my point of the work measurement system in sherman's point that if you give somebody some income and maybe he will go away if the thought

and there will anymore to do. so they really want to get rid of the case at that point. thank you. >> thank you. >> thank you very much, mr. chairman for having this important hearing. information that the va has provided a recently suggested simply breaking up the workload into what they call this segment of planes resulted in a 10% processing increased during the first 60 days. also easy claims saw an increase in timeliness of 100 days faster than the special operations claims. however, we know that va continues to do a poor job in handling them of our most challenging claims at va oig noted in their testimony in the first round of inspections. 31% of the tbi claims reviewed show that staff at errors.

after informing staff of errors and va taking action the va oig return to note that 29% at tbi claims reviewed were found to be in error. you look at 12 of the 20 offices reviewed were noncompliant with vba on it for two consecutive inspections. they also noted even after extremes amplification of ptsd claims, 5% of these claims are still incorrect. in my mind, the facts before themselves that we need to take the land further by creating a few specific hospices that specialize and focus is on complex claims like tbi and the end nst. these officers and specialists aligned in cross functional

teams focused and trained in extremely complex cases. i believe most of you at the table support h.r. 2088 that would create centers or adjudication excellence. my question, i'll start with mr. gill on. you articulate the problem with underqualified individuals handling complex claims. in your opinion would we be better off if we specialize in his complex medical conditions? the other two panelists can answer that as well. >> a fuss about qualifications and some of the cases i've seen more about the rules that constrain their ability to make judgments using the experience they might've accumulated over the years. the rules are just different. even in cases where you've got somebody qualified him of the rules are different. the rules say you have to do the steps.

you can no longer exercise common sense. if it says hospice common sense says that is probably skilled care. you have to ask for an exam at the raise the rating stands. it's an accurate rating. that's where you get an error. that's an error. you have to exercise reasonable doubt. that's an error of law. it really depends on the convergence of both an inexperienced corps of new readers who don't have the freedom to exercise their judgment when it's necessary. if you were to sort of compartmentalized in the knowledge, it depends on how you run it. if they are allowed to exercise that qualitative deliberative thought process as we look at these claims in these compartmentalized thinners of excellence, then it would work. i don't think that's necessarily

it. just give them the ability to make decisions in exercising good judgment and having rules dictated as a quality of review standard. >> thank you. first of all i think the asset the fairness is time. if we set up lanes and their pressure to go real fast, it won't matter if they're the most knowledgeable people on the planet. secondly, you are taking the veterans claim away from his local representative. the american legion or others of his organizations representative in boise, idaho, is not going to have access to the file or to you with the raiders if the case

goes to denver. i make you mad at, but that's a problem in any case. until you fix how they count their work these are fixes to sound good on paper but aren't going to make a major impact. that is the first thing to do. if sounds great. i also worry that if people are trained to deal in smc and that is all they do the rest of the va readers are not going to note since you must they're trained. they'll only have a small component of people to do it. there's a lot of roseanne comments. it's worth a try if we can also implement some way to give them time to do it or to higher a lot more people. i keep saying that. a lot more oil. thank you. >> thank you.

generally speaking, like bond said the idea of local adjudication for claims. i think what you are saying the vc were essentially going to create a workforce of warrant officers, whether specialize in particular areas. this is the thing that i kind of question. if you're a high-performing regional office in your assigned special monthly conference edition and you are working in a different office and assign something easier, what is that going to do to the morale for people working? i'm stuck with the tenebrous game. i don't think that it's necessarily the way you want to go about it. you have to have a comprehensive approach to training and evaluation. i was speaking earlier in our office about it.

10, 12 years ago when he passed no child left behind be concerned in the education community west teachers are going to start teaching to the test. but for some of the evaluations do. titus could attest to years in academia. you don't want to test knowledge of multiple-choice exams. that is comprehensive understanding and that is what our big concern is that the american legion. thank you. >> i thank the gentleman and i thank you call today for your testimony in the work you do on behalf of disabled veterans. you're excused from the witness table and we ask our third panel to come forward. [inaudible conversations]

found [inaudible conversations] [inaudible conversations] >> this'll be our final count today. we welcome mr. tom murphy director compensation service the veterans benefit administration all so this sub one of the regional office. we also welcome sondra mccauley deputy assistant general for audit evaluations of the office of inspector general department of veterans affairs. ms. mccauley is accompanied that mr. brent arronte, director of san diego benefit inspections division. we appreciate your attendance

today. complete amid statements will be in the hearing record. mr. murphy, you're now recognized for five minutes. >> chairman runyan ranking member tightness, thank you for providing me the opportunity to discuss va policies and procedures for adjudicating complex disability claims. the company today by ms. edna macdonald of the regional office. the vba continues to express an increasing number complexity number complexity of regional issues you between 2011 and 2013, the average number of issues and claims increased by 31% from 5.52 mike 72. in response, bba implement the new operating model. epa has noticed increase in complexity from the newer generations of veterans who participated in operations during iraqi freedom and udon. you can hear a greater chance of surviving are his injuries and often return home with multiple serious conditions. in addition, vba continues to receive credit for veterans of the vietnam era.

many become complicated because they are subject to federal court orders in the u.s. department of veterans affairs department of veterans affairs. organizational model incorporates cross functional teams working on one of three segmented lanes, express cooperations. things were created based on complexity and priority of claims. the express lane develops and writes claims with a limited number of issues and subject manner, which could be developed and rated more quickly. corley and includes claims that three or more medical issues that do not involve special populations of veterans. the special operations plane applies intense focus and case management on specific categories of things that require special processing or training. it's comprised a regional office most highly skilled personnel specialist experience and training. vba is simplifying ratings by building a decision support tools to make employees more action and decision are consistent and accurate. one of them is the evaluation

builder essentially an interactive reading schedule. the reader uses check docs is associated with the veterans events. dbq's are designed to simplify rating decisions. they replace exam reports and capshaw made the medical information up front and present the findings in a reader friendly format. grants or consider complex for a variety of reasons. here are three examples. due to complexities of reading tbi come the special operations and processes these claims. since march 2013, all of this site are required to complete specialist training. this web-based modules 22.5 hours and how to read a claim for residuals of tbi. due to the myriad of systems they may experience, it's unclear which symptoms are solely attributable to tbi. in october 2011, compensation service provided guidance that fighting should be related to the veteran's tbi condition unless such symptoms are clearly attributable to other process.

in addition, vba has instituted safeguards to ensure can distance the attackers. all are required tbi claims until the individual demonstrates 90% accuracy in reading such claims. as a result of these efforts cannot bba have a tbi increased to 21% of best-of-seven to 47% in 2013. further, accuracy of rating during fiscal your 13 with 92.37% from a slightly higher than national average for operating claims are in the same period. service connection for ptsd requires three things. medical evidence diagnosing the condition and in-service stressor in a nexus connect the two. in 2010 secretary should seki made it easier to establish and provide the statement alone can now establish the required service trust. via provided training on this regulation change to ensure can just inaccurate ratings.

he raised ptsd claims are processed by this thing as well. complications arise in situations where there is no collaborating evidence in the veteran's military records. in these cases come the va must notify the veteran the evidence from outside attorney records may be used to support the claim ms attempt to obtain any such evidence identified. in 2011, bba connect quality review of these claims which found approximately 25% error rate based primarily on incomplete development. we developed and implemented an mst-based ptsd package and emphasize the recognition of the types of evidence. following the training fst-based ptsd is a level level comparable to that of other level for ptsd. the va has been complexity of claims in recent years here to address the trend, va implemented in mono special operations focusing on complex disability claims.

this concludes my statement mr. chairman. i'd be happy to entertain any questions you are the subcommittee may have. >> thank you mr. murphy. without i recognize ms. ms. mccauley. >> mr. chairman is set to become a thank you for the opportunity to express work in the claims processing issues. with me today is mr. brent arronte, director of the san diego inspection division. in addition to a nationwide potted some of the oig reports on individual effect msm providing timely and accurate benefits and services to veterans. a major concern is continued noncompliance with vba policy despite recommendations for addressing issues we identify. specifically in response to may 2011 report bba required second signature reviews of tbi claims until they rate 90%

accuracy and claims processing. however, in fy 2013 can we saw slight improvements. they remind for two consecutive inspections. half of the hours were due to staff using inadequate medical exams to great tbi claims. in january 2011 we projected vba and correctly process 15% of hundred% disability evaluations for about 181000 veterans and paid 943 million without adequate supporting medical evidence. he va implemented training in internal controls to address this issue. however, bba continually cover repeatedly delayed completing its review of all hundred% disability evaluations to ensure each had a future examination

date entered in the electronic record. a second cycle of inspections continue to show a high error rate in processing these evaluations. in most cases, errors occurred when staff did not enter suspense diaries in vba's electronic system to request medical re-examinations as required. we continue to review the va's systematic analysis of operation and organized means every great veteran service under dsp operations to identify problems and propose correct elections. we found six barrels remain noncompliant in this area are both cycles of our inspections. generally, bear management did not provide adequate oversight to ensure sales timelier complete. we correlation to sao noncompliance in bank into a temporary director or manager positions for advance or

greater. currently, we are assessing bba's initiatives to improve claims processing and eliminate the backlog. we are reviewing the initiative vba began on april 19, 2013 to process within 60 days i'll claims over two years old. i've know we determined 10 of 11 provisional rating decisions at the los angeles burial were not compliant with vba guidance. we found the director's office had enough conflict think i'd just ask or require provisional ratings without supporting medical evidence. concerned that additional errors they exist we recommended that bba review for accuracy all 170 provisional rating completed by the los angeles bureau after the conflict has issued. findings from our ongoing audit of the veterans benefit management system, vba suggests in progress.

while vba has reduced its inventory of average days to complete claims, we cannot determine another transformation initiatives. moreover, a behalf as has performed issues and uses legacy systems to process claims. we've initiated a review to determine the extent to which vbms helps va with the decisions. we hope to report finance and early 2014. in conclusion, vba has made progress, but continues to face challenges to improving processing accuracy and time limits. inefficiencies we not only added burden of delays veterans, but also improper payments that bba will not likely recover. we will continue to look for ways to promote improvement in vba delivery during our future audits and inspections.

mr. chairman this concludes my statement. we would freeze to answer any questions you or members of the subcommittee may have. >> thank you. i'll begin with the round of questions for mr. murphy. we will both touch on it. it must have been given one word for accuracy. mr. murphy, the va uses the term accuracy this morning. we heard from veterans representatives and office of inspector general who indicated claims are not being correctly decided at a very high to. development of the medical examinations are not adequate. they are not consistently returning to report to facilities is required due to pressure to meet production requirements. in a moment or thank you to explain in detail how va calculates and represents a 91 claims based accuracy.

i find the va's representations of accuracy to be even more concerning to be over 92%. it specifically tasked to perform reviews of claims and reports over 30% of cases nationally employees are not compliant with policy if individual error rates as high as 51st and peers so here's the question. does accurate standards mean the veteran received the correct rating decision for the claim conditions on full and proper the claim in the factory indicates anything less than this, what does this mean? >> accuracy means exactly what you said, mr. chairman. to the veteran was he the proper benefit entitlement payment or decisions into my? best measure of accuracy and a vet quality analysis and

reported out. that's at the 91% means. that number is drawn from a true statistically valid nationwide sample, random sample applied to regional offices, elected in the national leachman evaluated returned to the office and found that sun is rolling 12 month efforts. >> would describe it with the oig numbers? >> vig and dba don't measure what an error is back with the same way. did the benefit entitlement iran number one intends to look at it from the standpoint of did you follow the process? if you're very further process got the benefit and title decision right, i will not call that an error. however, the ig will. something more important you need to hear from the ig report that says resample claims we consider at higher risk of processing errors. best these results do not

represent the overall accuracy of disability claims processing and this va regional office. this is a page from the title of the ig report. there is one of these initial report. the ig by design targets a specific subset of knowing high errors. if you take that number and extrapolated out to see the entire regional offices this way, to .. or represent tatian the sum of work for the regional office here that i'm not disputing that is an accurate representation for the subset they look at. but not for the totality of work that comes out of the office. >> i'm having the discussion that we had also broken down to just tbi cases in your numbers conflict fair. >> yes, our numbers conflict fair. the ig report to look at her with a years of work. the numbers i give you are some

of the last 90 days worth of work. my point is this. when you look at where we were and where we are and the ig report is much but reflect it up where we wear, not necessarily where we are sitting out today. >> ms. mccauley, caterers onto that? >> yes, the numbers we reported with the 31% accuracy -- error rate was based on a first round of inspections from 2009 to 2012. more recently we found a 29% rate with the 2013 inspections. we do look at specific high-risk types of claims. and so, we are not looking across all the different kind of claims to come up with an accuracy rate, but rather to focus and undoes tbi or

temporary 100% disability evaluation better shown repeatedly to have a high error rate. also, there is a big difference in terms of how we call errors and how vba calls errors. we don't focus just on the benefits and titles. when we look at the claims, we look at the processing of the claims human error, system error, processing error. did they follow regulations that goes into the accuracy of the claims? sometimes the benefits entitlement may be correct for a moment but sometimes errors have potential impact on benefits down the road future benefits for the veterans. so we look at the totality of the claims processing so we look at the totality of the claims processing exercise. >> one more question, talking about how you compile statistics. does the va keep track of accuracy in appeal of a number of years of experience by the

dro? >> from the standpoint of i can go back to my office and give your part that says no, i don't reported that we had a routine basis. however, in determining the training we do in the types of training, where we spend our affair, where the errors come at a high concentration of errors, i use that data every single day to determine exactly what training they need to be doing where you need to be concentrating that come even done to the regional office level by tracking and looking at errors than an issue-based level, which were started doing more than a year ago at this point, i now have the ability to stay tbi is a high error rate in the regional office and target just the tbi as an example. so to go back to the office and say here it is, no i don't track it that way.

in all of the training process we do, that information is good uttered on a regular basis. >> where my head is on this is it because of a lack of asked. that sum of all? they came back in the last panel that maybe we don't even have enough people with the experience to rate these things. is that trackable in your statistics? >> when i go back to your first question mr. chairman. this is an excerpt from the waco report. the two met at brain injury review 30 cases in errors that affect veteran benefit zero. potential to affect veteran benefits, the difference of rules between how the ig looks at it and how i'd look at it is eight out of 30. there was a 30% error rate you are talking about. the veteran received the right check? gas. with a process done differently but they got the right check? in error in the ig and the

veteran focus was the right decision in the right compensation received by that veteran. >> but i'm trying to ask is it possible to find the analysis of some of that has more experience in phase certain regional office has more experienced personnel in it, are you getting a better outcome there? >> re: get a better output -- >> with the experience of the claim adjudicator? >> yes, no question. we track that. in fact, we call the consistent he studied the first week of office. we broke it on the it on the six questions to all people. this one has been to be on diabetes. what we did is broken down by lanes. we broke it down for the quality review teams. i lay out the segment population at a glance and by a meaning in the mid-90% french, the special operations plane got those

questions right at a much higher percentage. at the 93%, 94% where the average for the population was in the mid-80s. the point being the higher experience level better education and more training with those individuals is yielding better results market distant results. at the same time we are concentrating those more trained, more experienced people on the most complex conditions we are dealing with. >> if at all possible that you have staff be able to reach out at you and take a look at those numbers. >> yes sir. happy to provide. >> recognize the ranking member, ms. titus. >> thank you, mr. chairman. i'd like to recognize those to if we can get them back into some order order to time. mr. murphy, i'd be happy to talk about a a rate as effective at the notion of the three different lanes and how to deal with complex cases.

we know that the va has the authority to do pay as you rates. i wonder if you would talk about that. talk about what the problems are why you don't use up more often and is that they probably can address that how you compensate the people who make these decisions based on a full claim decided or parkland decided to address these concerns brought up in the previous panel. being that the previous panel product comments about you didn't get credit for it so it wasn't worth it. without saying yes that's right, no that's not right, let's take that as a base to talk about what we put in place actively right now, which is exactly what you're describing. received acclaim from permit better with 10 issues. break that down into 10 issues and have one great time for 10 readers with one each. break it down to 10 individual issues and make decisions on the 10 individual issues and compensate the veteran if they're entitled to it as the

rating decisions become -- as they're made aware before to do the other. the problem with madison assistant right now today, that is very difficult to do. there are some barriers in terms of its much less efficient in the amount of time it takes our overall process to rate 10 individual issues at one each. the fixes we put in place will allow that to go significantly faster and been our intent is to do exactly that, which is rate by issue. so we understand within your bill. they testified on that previously that we've agreed without the concept. at this point in time there were complications due to her system limitations. >> when you anticipate those changes will be made? >> i can't put an exact day. what i can tell you is every 90 days be doing a release. i'm not sure which one of those releases that some of these changes are in.

one of the changes that is going in and being piloted right now is the vbms authorization mumble and when they been in place to help these individual issues as they are deciding to go through the system quicker. in other words when i had the vbms authorization model in place come all process individual issues without impacting the total system time. >> will there be safeguards in place so you don't just pay a better and offer a few things and think it will go away as opposed to really do complete? >> we are looking to break in the stance that comes then as a single claim but it is posted in our system and we track it as though they are 10 individual claims. this isn't just i'm going to receive a claim in break it up by issues. this is the true issue based quality, everything. >> i know that some of the cases in the reno office have been

farmed out to other offices where they can emit vast and stuff like that. if you start break in the claim done so some things are easy and a more complex and you end up into different lanes you're not going to end up into different places to have your claim completely considered? >> well, depending on mr. or ms. those question a little bit ago about centers of excellence, we certainly need to consider whether those different issues into different lanes even need to be in the same regional office. why a figure with the concept of centers of excellence in the trade happens to be on issue number one in st. petersburg issue number two. why would we not send that claim quite i can move them around the country with a few keystrokes. we still don't have the final this is exactly how it is going to be, but weeks are the options from how i get it to her system right and fast. >> we just don't want to make it

more difficult for a veteran to track where their claim is or understand what is happening with it and when it is happening without scattering it around or making it more complicated. >> yes. you are seeing one of the information points you are interested in is from the reno office. >> we are waiting for some of those answers. >> just under 700 right now. you've heard what we are doing with the 2-year-old claim and 1-year-old claim and now to the 334 days. if the capacity of the regional offices in place to meet timelines we put into meet these different deliverables on the oldest claims, we ship them off to other regional offices. in other words we make the oldest claim issue a national problem and not one type to a particular regional office. it just so happens in reno today they have a large number of the older claims. they sent those to other offices that have capacity to give veterans done in a timely manner. thank you. >> i think the gentlelady.

>> thank you, mr. chairman. i want to thank the panel as well for the testimony today. mr. murphy vba currently adjudicate claims related to camp with june in louisville, kentucky. and claims related to radiation in mobile, alabama. can you explain to the committee why this is? >> those claims actually fall under the title of this hearing. they are complex claims. they are highly complex claims. but we don't want to do is have a veteran because they went to regional office ones get one decision an equivalent case in a different rating decision. in order to do that in order to concentrate efforts in the way we do claims in a paper world we concentrated them in single places. we provide special training for the processors and raters to work the claim at the same time we worked with dha and provided training to the individual cmp

examiners that work these conditioners and send a factory single jointly trained rating board so they get a consistent accurate output. >> so those two areas are specialized in this particular -- >> yeah. >> for the oig ms. mccauley, your inspections on this difficult medical conditions, how often is training and a lack of knowledge regarding policies and procedures a problem? how often is that? >> it certainly has shown itself to be a problem as a result of our inspections. ..